Current Issue

2024 Vol.9 No.5 Published:31 October 2024

Original Articles

Analysis of the efficacy of bedaquinoline-containing regimen in adolescents with resistant pulmonary tuberculosis Jiang Ling, Xia Mingqiang, Liang Lijun, Xin Junqiu, Yan Xiaofeng 2024, 9 (5):  1-7.  DOI: 10.19871/j.cnki.xfcrbzz.2024.05.001 Abstract ( 43)    PDF (1031KB) ( 47 )    Objective To retrospectively assess the efficacy of bedaquiline in combination with conventional anti-tuberculosis (TB) drugs in treating 21 adolescent patients with drug-resistant pulmonary tuberculosis. Provide a basis for the treatment of drug-resistant pulmonary tuberculosis in adolescents. Method A total of 21 adolescent patients under the age of 18 with drug-resistant pulmonary tuberculosis who were treated with the bedaquiline-containing regimen at Chongqing Public Health Medical Center between January 2021 and October 2023 were enrolled, including two patients with rifampicin-resistant tuberculosis (RR-TB), 11 patients with multidrug-resistant tuberculosis (MDR-TB), and 8 patient with pre-extensively drug-resistant tuberculosis (pre-XDR-TB). The effectiveness of treatment was evaluated by analyzing the resolution of clinical symptoms, sputum culture conversion rate, and improvement in lesion absorption 24 weeks after treatment, as well as by analyzing the occurrence of adverse drug reactions such as changes in the QTc interval on electrocardiograms to assess safety. Result One patient completed a 12-week course of bedaquiline-containing treatment, whereas 18 patients finished a 24-week course and two finished a 28-week course. with a clinical symptom relief rate of 100%. Sputum culture conversion was achieved at 24 weeks in 90.5% (19/21) of patients and at 36 weeks in 100% (21/21) of patients, with the fastest time being at the end of 4 weeks of treatment and the median time being 8 weeks. Chest CT scans showed significant improvement in 10 cases and effectiveness in 11 cases. The treatment success rate was 100%。Adverse drug reactions included two cases of QTc interval prolongation, ten cases of drug-induced liver injury, six cases of hyperuricemia, two cases of peripheral neuropathy, two cases of optic neuritis, two cases of gastrointestinal reactions, one case of myelosuppression (mild anemia), and one case of drug-induced dermatitis. The majority of adverse drug reactions were mild (90%). The prevalence of QTc prolongation was 9.52%. Conclusion In the treatment of drug-resistant pulmonary tuberculosis in adolescents with bedaquinoline-containing regimen, the clinical symptoms were improved quickly, the time of negative conversion was short, the foci were absorbed well, the treatment success rate was high, and the incidence of QTC interval was low, the rate of grade 3 or above adverse events was low and the safety was high.

Subtype characteristics and drug resistance analysis of newly reported patients with HIV/AIDS before antiviral treatment in Nanning,2020-2023 Li Xuehua, Liu Jie, Huang Jinping, Lu Huan, Liu Xin, Qin Qiuzhen, Li Yangping, Ye Li, Li Yanjun 2024, 9 (5):  8-13.  DOI: 10.19871/j.cnki.xfcrbzz.2024.05.002 Abstract ( 159)    PDF (788KB) ( 38 )    Objective To analyze the prevalence of HIV-1 genotypes and the transmitted drug resistance in HIV/AIDS patients before antiviral treatment from 2020 to 2023 in Nanning City,provide a reference for the development of prevention and control strategies for newly reported HIV infections in the region. Method 374 whole blood specimens from newly confirmed non-ART HIV/AIDS patients in Guangxi from January 2020 to December 2023 were collected for HIV-1 drug resistance testing. After extracted nucleic acids were reverse transcribed, the HIV-1 pol region gene was amplified by nested PCR and sequenced by Sanger sequencing, and the sequence information was analyzed according to tools such as the Stanford University HIVdb Program Drug Resistance Database. Result A total of 346 samples were successfully sequenced. Among them 9 subtypes were detected, mainly CRF01_AE subtypes and B/C recombinant, accounting for 29.48% and 27.46%. The subtype distribution between males and females was significantly different, and the subtype distribution in different sex-transmitted infections was also significantly different（P<0.05）. The overall drug resistance rates of PDR was 8.09%(28/346) with 2.89% to NRTIs, 3.75% to NNRTIs, 1.73% to PIs, and 0.29% to INSTIs. The drug resistance mutation rate of genotypic subtypes was 22.83% (79/346), and the mutation rates of resistance sites for NRTIs, NNRTIs, PIs and INSTIs were 4.91%, 15.32%, 2.02% and 2.31%, respectively. Conclusion Newly reported patients with HIV infection/AIDS in Nanning City are mainly CRF01_AE subtype HIV-1 infections, meanwhile, the pre-ART resistance rate has reached a medium-high level, and INSTIs resistant strains have emerged. Surveillance of HIV-1 subtypes prevalence and the drug resistance monitoring of newly reported HIV-infected people before ART need to be strengthened.

Characteristics of rotavirus infection in newborns hospitalized in a hospital from 2022 to 2023 in Liangshan Prefecture Luo Jiping, Yu Qiong, Song Lijuan, Xiao Chenxi, Luo Gangqun, Cai Zhao, Xu Tao, Ye Rucong, Li Xingfeng, Chen Qixiong 2024, 9 (5):  14-18.  DOI: 10.19871/j.cnki.xfcrbzz.2024.05.003 Abstract ( 43)    PDF (761KB) ( 26 )    Objective Investigate the characteristics of rotavirus infection in hospitalized newborns in Liangshan area from 2022 to 2023, Based on data analysis, develop prevention and control measures to provide scientific basis. Method This study is a multi-center survey, selecting 6 county-level hospitals in Liangshan area (Xichang People's Hospital, Liangshan Prefecture Maternal and Child Health Hospital, Xichang Maternal and Child Health Hospital, Liangshan Zhaojue County Hospital, Xichang Mianning County Hospital, and Liangshan Yuexi County Hospital). 2918 stool samples were collected from newborns aged <28 days in the neonatal ward from January 2022 to December 2023, including 1393 in 2022 (65 diarrhea samples and 1328 non-diarrhea samples), and 1525 in 2023 (diarrhea samples). 77 samples and 1448 non-diarrhoeal samples), the samples were tested for rotavirus and the infection characteristics were analyzed. Result Among 2918 newborn stool samples, a total of 82 samples were positive for rotavirus, with a positive rate of 2.81%. The positive rate of rotavirus among newborns with diarrhea was 34.51% (49/142). The positive rate of rotavirus in neonates without diarrhea was 1.19% (33/2776), and the positive rate between the two was significantly different (P<0.05); the positive rate of rotavirus in neonates with vomiting was 34.75% (49/141), and the positive rate of rotavirus in neonates with non-diarrhoea was 34.75% (49/141). The positive rate of rotavirus in neonates with vomiting was 1.19% (33/2777), and the difference between the positive rates was significant (P<0.05); the positive rate of rotavirus in neonates with fever was 35.00% (49/140), and the positive rate of rotavirus in neonates with fever was 35.00% (49/140). The positive rate of rotavirus in newborns was 1.19% (33/2778), and there was a significant difference between the two positive rates (P<0.05). Neonatal rotavirus infection can occur throughout the year, with the positive rate from July to September being <1.5%, and the positive rate from December to February being higher, both >4.5%. There is an obvious seasonal peak of rotavirus infection in neonates in both groups, with a higher detection rate from December to February of the following year; whether there is diarrhea, gestational age, birth weight, feeding method, and NICU admission status all affected the rotavirus infection rate (P<0.05); newborn gender, mode of delivery and age did not affect the rotavirus infection rate (P>0.05); 25.00% of children with rotavirus infection developed diarrhea symptoms. Conclusion Rotavirus infection is an important cause of neonatal diarrhea. The peak of rotavirus infection is concentrated from December to February of the following year. The infection rates of neonates of different ages are significantly different. Interventions in diarrhea, gestational age, feeding methods, and NICU are needed. Based on high-risk factors such as the occupancy status and the epidemiological characteristics of rotavirus, laboratory examinations of rotavirus suspected infected neonates were completed immediately after admission.

Analysis on epidemic characteristics and treatment effect of pulmonary tuberculosis in Chengdu from 2012 to 2022 Duan Xiaofei, Wu Guihui, Yang Jie, Jiang Liangshuang 2024, 9 (5):  19-24.  DOI: 10.19871/j.cnki.xfcrbzz.2024.05.004 Abstract ( 51)    PDF (984KB) ( 29 )    Objective To analyze the change trend of pulmonary tuberculosis patient registration and management and the influencing factors of treatment outcome in Chengdu, Sichuan Province, from 2012 to 2022, so as to lay a foundation for further formulating tuberculosis prevention and control strategies and measures in Chengdu. Method The data related to the registration and management of tuberculosis in Chengdu from 2012 to 2022 were collected through the "Tuberculosis Information Management System", a subsystem of the "China Disease Prevention and Control Information System". The change of the registration and management rate of tuberculosis from 2012 to 2022 was analyzed by the trend analysis of the Joinpoint regression model, and the influencing factors of the treatment outcome of tuberculosis patients were analyzed by the multi factor logistic regression analysis. Result From 2012 to 2022, a total of 69421 active tuberculosis patients were registered in Chengdu, with males, farmers, and middle-aged and young people as the main population, and with an average annual registration rate of 45.49/100 000. The overall registration management rate showed a downward trend, with an average annual decrease of 6.09% (AAPC=-6.09%, t=-9.37, P<0.001）. The downward trend has statistical significance. The segmented results of Joinpoint regression model showed that the registration and management rate of pulmonary tuberculosis decreased by 7.75% year by year from 2012 to 2016, and the trend was statistically significant (APC=-7.75%, t=-11.53, P<0.001). The downward trend slowed down to 3.54% from 2017 to 2022 (APC=-3.54%, t=-2.76, P=0.03). There was no statistically significant increase in the registration and management rate of pathogen positive patients from 2012 to 2022 (AAPC=0.87%, t=0.79, P=0.43）. However, from the segmented results, the registration and management rate of pathogen positive patients showed a downward trend from 2012 to 2016 and was statistically significant (APC=-9.67%, t=-4.76, P=0.003）. But from 2017 to 2022, the registration and management rate of pathogen positive patients showed an upward trend and had statistical significance (APC=8.57%, t=7.20,P<0.001）. The average annual registration and management rates for males and females are 62.25/100 000 and 31.03/100 000, respectively. The ratio of male to female registration and management rates is 2.01:1, with males having a higher rate than females (χ2=708.084, P<0.001). The patient composition is relatively high among young people aged 20 to 29 (22.12%) and farmers (44.10%). Univariate and multivariate regression analysis of treatment:Male, age, farmer, pathogen positive, and retreatment are important influencing factors on patient prognosis. Conclusion From 2012 to 2022, the registration and management of pulmonary tuberculosis in Chengdu showed a stable downward trend. Pathogenic positivity and re treatment increased the risk of adverse outcomes. The next step is to focus on strengthening the publicity, education, and screening efforts of males, students, and middle-aged and elderly populations; Strengthen the treatment and follow-up management of patients with positive and recurrent pathogens.

Analysis of clinical features and influence factors of patients with post-tuberculosis chronic pulmonary aspergillosis Zeng Jian, Wang Jin, Fang Mutong, Zeng Jianfeng, Lu Shuihua, Huang He 2024, 9 (5):  25-30.  DOI: 10.19871/j.cnki.xfcrbzz.2024.05.005 Abstract ( 52)    PDF (781KB) ( 25 )    Objective To analyze the clinical characteristics and influence factors of chronic pulmonary aspergillosis (CPA) after tuberculosis to improve clinicians' understanding of post-tuberculosis CPA. Method From April 1, 2021, to April 30, 2023, 59 patients with chronic pulmonary aspergillosis who had a history of pulmonary tuberculosis were treated in the inpatient department of Third People's Hospital as the observation group (CPA group), and 118 patients with old pulmonary tuberculosis who did not have pulmonary fungal infection in the same period were selected as the control group (non-CPA group), and the clinical indicators of the two groups of patients were compared. The influence factors for the onset of CPA were analyzed by univariate and multivariate logistic regression analysis. Result Among 59 CPA patients, aspergillus fumigatus accounted for 80.5% (37/46). Univariate analysis showed that the proportion of lean patients in the CPA group was significantly higher than that in the non CPA group (P<0.05). The proportion of CPA combined with lung damage, chronic obstructive pulmonary disease, or bronchiectasis was higher in the non CPA group (P<0.05). The CPA group had a longer history of anti-tuberculosis treatment compared to the non CPA group (P<0.05). The proportion of patients with cough, sputum, hemoptysis, shortness of breath, or weight loss in the CPA group was higher than that in the non CPA group (P<0.05); The imaging manifestations of the CPA group were higher in terms of cavities, air crescent sign, consolidation, and mass shadows than those in the non CPA group; while the proportion of nodular shadows was lower than that in the non CPA group (P<0.05). The proportion of patients with hypoproteinemia, abnormal C-reactive protein, or erythrocyte sedimentation rate in the CPA group was higher compared to the non CPA group (P<0.05). The levels of hemoglobin and serum albumin in the CPA group were lower than those in the non CPA group (P<0.05). Multivariate logistic regression analysis showed that BMI (OR=0.865, 95% CI:0.767-0.976, P=0.018) and destroyed lung (OR=5.833, 95% CI:1.922-17.698, P=0.002) were independent influencing factors of post-tuberculosis CPA. Conclusion Aspergillus fumigatus is the main pathogen in post-tuberculosis CPA. The main symptoms include cough, sputum, hemoptysis, weight loss, and shortness of breath. Clinical manifestations include emaciation and hypoalbuminemia; elevated C-reactive protein and erythrocyte sedimentation rate. The pulmonary imaging lesions are mainly characterized by consolidation and mass shadows, with lesions characterized by cavities and air crescent signs as the main manifestations; Tuberculous lesions and low BMI are independent influence factors for chronic pulmonary aspergillosis after tuberculosis.

Expression significance of interleukin 17, platelet to lymphocyte ratio, vascular endothelial growth factor in serum of hepatitis B virus infected patients and their correlation with disease progression Ni Huihui, Pan Gaofeng, Chen Shujun 2024, 9 (5):  31-35.  DOI: 10.19871/j.cnki.xfcrbzz.2024.05.006 Abstract ( 52)    PDF (997KB) ( 37 )    Objective To investigate the significance of serum interleukin 17 (IL-17), platelet-to-lymphocyte ratio (PLR), and vascular endothelial growth factor (VEGF) expression and their correlation with disease progression in hepatitis B virus (HBV) infected patients. Method Eighty-two HBV-infected patients admitted from June 2022 to March 2024 were selected as the study group, and according to the degree of disease progression, the 82 patients were divided into 37 cases of group A (chronic hepatitis B), 24 cases of group B (compensated cirrhosis), and 21 cases of group C (decompensated cirrhosis), and 30 healthy medical check-ups were selected as the control group. In addition HBV-infected patients were classified into 18 cases of negative group (<1.0×105copy/ml), 26 cases of low load group (1.0×105~1.0×108copy/ml) and 38 cases of high load group (>1.0×108copy/ml) according to serum HBV DNA load. Serum IL-17, PLR, VEGF expression levels and HBV DNA load were detected in all subjects, and the correlation between serum IL-17, PLR, VEGF expression levels and disease progression was analysed. Result The serum IL-17, PLR, and VEGF expression levels of patients in the study group were significantly higher than those in the control group (P<0.05), and the serum IL-17, PLR, and VEGF levels of patients in group C were significantly higher than those in group B and group A, whereas those in group B were significantly higher than those in group A. The serum IL-17, PLR, and VEGF levels of patients in the high-load group were significantly higher than those in the low-load and negative groups, while serum IL-17, PLR, and VEGF levels in patients in the low-load group were significantly higher than those in the negative group (all P<0.05), Pearson correlation coefficient analyses of elevated serum IL-17, PLR, and VEGF levels were positively correlated with HBV DNA load, compensated cirrhosis, and decompensated cirrhosis (P<0.05), and multifactor Logistic regression analysis showed that elevated IL-17, PLR, and VEGF expression levels were all risk factors for disease progression (P<0.05). The AUCs for the combined diagnosis of compensated cirrhosis and decompensated cirrhosis using serum IL-17, PLR, and VEGF are 0.823 and 0.835, respectively. Conclusion As important biomarkers reflecting HBV infection and disease progression, changes in the levels of serum IL-17, PLR and VEGF are closely related to HBV DNA load, compensated cirrhosis and decompensated cirrhosis. By monitoring the changes in the levels of these cytokines, it helps us to more accurately assess the severity of the disease and prognostic risk of HBV-infected patients, and provides a valuable reference basis for clinical diagnosis and treatment.

The rs1801133 locus of MTHFR was significantly associated with multiple solid small nodules in the lung Mo Junluan, Liu Jinhong, Lei Lin, Zheng Kexin, Dai Juanxiu, Yin Jiye, Liu Zhaoqian, Li Xi, Liang Xiongshun, Hong Wenxu 2024, 9 (5):  36-41.  DOI: 10.19871/j.cnki.xfcrbzz.2024.05.007 Abstract ( 37)    PDF (1024KB) ( 31 )    Objective To understand the relationship between multiple solid small nodules in the lung and the single nucleotide polymorphism loci (SNP) of lung cancer susceptibility genes. Exploring risk markers for early-stage lung cancer. Method Urban residents aged 40-74 were recruited to undergo low-dose spiral computed tomography of the lungs from June 2017 to October 2018. The population with multiple pulmonary small nodules was selected as the positive group, and the patients without pulmonary lesions were selected as the negative control group. There were 14 SNPs loci associated with lung cancer susceptibility were detected separately. The distribution of SNPs between the two groups and their association with multiple solid small nodules in the lungs were analyzed. Result The genotyping results showed that only the rs1801133 locus of the methylenetetrahydrofolate reductase (MTHFR) gene was significantly different in the genotype frequency distribution between cases and controls (P=0.027). The risk of multiple solid small nodules in the lungs was lower in those with AA genotype than those with GG genotype （OR=0.45,95%CI：0.23-0.57,P=0.017）. And the risk of multiple small nodules showed a decreasing trend (Ptrend=0.008). In addition, the results of the dominant model analysis showed that the population carrying the AA+AG genotype had a lower risk of developing multiple solid small nodules in the lung than the population carrying the GG genotype (OR=0.59,95%CI：0.39-0.90,P=0.014). Conclusion We found that MTHFR rs1801133 was significantly associated with multiple solid small pulmonary nodules.

Analysis of risk factors for invasive pulmonary aspergillosis secondary to fever with thrombocytopenia syndrome Chen Jun, Xiao Lingyan, Shi Dongyang, Liu Yongfu, Yang Kai, Cui Daguang, Zheng Yishan 2024, 9 (5):  42-46.  DOI: 10.19871/j.cnki.xfcrbzz.2024.05.008 Abstract ( 39)    PDF (806KB) ( 35 )    Objective To explore the risk factors associated with Invasive Pulmonary Aspergillosis（IPA） secondary to Severe fever with thrombocytopenia syndrome（SFTS）through retrospective analysis. Method A total of 109 patients with SFTS were confirmed in the Second Hospital of Nanjing from January 2020 to November 2023. There were 14 cases with IPA and 95 cases without IPA. SPSS 26.0 was used for univariate and multivariate analysis, general data, inflammatory and immune indicators, and degree of organ damage between the two groups were compared. Result All 109 patients were sporadic, 50 males and 59 females, with a median age of onset of 68 years. In univariate analysis, the levels of procalcitonin, C-reactive protein, serum interleukin 6, CD3+T lymphocytes, CD4+T lymphocytes and CD45 lymphocytes in the IPA group, as well as the proportion of mechanical ventilation, blood purification and vasoactive drug treatment in the none-IPA group were lower than those in the IPA group (P<0.05), while the serum albumin levels in the none-IPA group were significantly higher than those in the IPA group (P<0.05). Logistic regression analysis showed that serum albumin and mechanical ventilation were influencing factors for IPA (P<0.05), serum albumin level (odds ratio=0.78) was a protective factor for the development of IPA, and mechanical ventilation therapy (odds ratio=9.80) was a risk factor for the development of IPA. ROC multiplex analysis showed that the combination of mechanical ventilation and a decrease in serum albumin levels could be used to predict the occurrence of IPA (AUC=0.845). Conclusion mechanical ventilation and decreased serum albumin levels are independent risk factors for the development of IPA, which can be used alone or in combination to predict the occurrence of IPA in patients with SFTS. In addition, it provides a clinical reference for preventing the occurrence of IPA, preemptive antifungal therapy, and reducing the mortality rate.

Diagnostic value of Epstein-Barr viral load and CD4+T lymphocyte in poor prognosis of infectious mononucleosis in children Niu Wenze, Yang Wenyan, Zhang Hongqiang 2024, 9 (5):  47-52.  DOI: 10.19871/j.cnki.xfcrbzz.2024.05.009 Abstract ( 37)    PDF (852KB) ( 32 )    Objective To explore the diagnostic value of Epstein Barr virus (EBV) DNA load and CD4+T lymphocytes in poor prognosis of infectious mononucleosis (IM) in children, so as to provide strong support for clinical decision-making. Method 120 children with IM admitted to the Department of Pediatrics of our hospital from January 2022 to January 2024 were selected as the IM group, 100 children with EBV infection who did not develop into IM were selected as the non-IM group, and 90 healthy children with physical examination were selected as the control group. Clinical data, peripheral blood T lymphocyte subsets and EBV DNA load were collected. According to the EBV DNA turned negative after 14 days of treatment, the children in IM group were further divided into a good prognosis group and a poor prognosis group. The differences among the groups were statistically analyzed and compared, and the diagnostic value of each index was evaluated by multivariate Logistic regression analysis and ROC curve. Result Before treatment, EBV-DNA load in IM group was significantly higher than that in non-IM group (P<0.05), and CD4+T lymphocyte level was lower (P<0.05). After 14 days of treatment, 77.5% of the children in the IM group had negative EBV-DNA. The EBV-DNA load before treatment in the poor prognosis group was significantly higher than that in the good prognosis group (P<0.05), and the CD4+T lymphocyte level was lower (P<0.05). Multivariate Logistic regression analysis showed that EBV DNA load, white blood cell(WBC), lymphocyte(Lym), abnormal lymphocyte count, norepin ephrine(NE), CD4+T lymphocytes, CD4+/CD8+T lymphocytes levels were all factors affecting the poor prognosis of children with IM. ROC curve analysis showed that EBV DNA load combined with CD4+T lymphocytes was more effective in predicting prognosis than a single indicator. Conclusion EBV DNA load and CD4+T lymphocyte level are important indicators to predict the prognosis of children with IM, and the combined detection of EBV DNA load and CD4+T lymphocyte level can significantly improve the diagnostic efficiency.

To explore the diagnostic efficacy of sound touch elastography in chronic hepatitis B liver fibrosis Yuan Li, Ge Juan, Yuan Yufeng, Feng Xuan, Dong Changfeng 2024, 9 (5):  53-58.  DOI: 10.19871/j.cnki.xfcrbzz.2024.05.010 Abstract ( 38)    PDF (1605KB) ( 39 )    Objective To explore the value of sound touch elastography (STE) in evaluating the degree of fibrosis in chronic hepatitis B (CHB) and analyze the efficacy of STE in verifying fibrosis. To provide a new reference for staging the degree of liver fibrosis in patients with chronic hepatitis B. Method 264 patients with CHB liver fibrosis and 59 healthy volunteers were selected from February 2022 to March 2023. After liver puncture, the patients with liver fibrosis were divided into mild liver fibrosis group (113 cases), moderate liver fibrosis group (59 cases), severe liver fibrosis group (52 cases) and cirrhosis group (40 cases). The healthy volunteers were included in the normal control group. The general data and laboratory test indexes of each group were compared to evaluate the stage of liver fibrosis. Receiver operating characteristic curve (ROC curve) was used to evaluate the diagnostic value of STE in different degrees of liver fibrosis. Result In cirrhosis group, splenic vein diameter (SPV), total bilirubin (TB), aspartate aminotransferase (AST), hyaluronic acid (HA), propeptide Ⅲ peptide (PⅢP) and type Ⅳ collagen (CⅣ) were the highest, while platelet count（PLT) was lowest. There were no significant differences in spleen length, alanine aminotransferase (ALT), AST, HA, PⅢP, CⅣ between the mild hepatic fibrosis group and the moderate hepatic fibrosis group (P>0.05), while there were statistically significant differences in spleen thickness and PLT between the two groups (P<0.05). Both liver STE and spleen STE were increased with the aggravation of liver fibrosis (P<0.05). The AUC of the ROC of STE in diagnosing mild, moderate and severe liver fibrosis were 0.853, 0.802 and 0.989, respectively. Conclusion STE has a significant effect in evaluating the degree of liver fibrosis in patients with CHB, STE has good diagnostic efficacy for staging liver fibrosis.

Analysis of clinical characteristics and prognosis of cases of human to human severe fever with thrombocytopenia syndrome Wang Hui, Hu Lifen, Dong Jing, Chen Ling, Xue Ping, Chu Xueqin 2024, 9 (5):  59-63.  DOI: 10.19871/j.cnki.xfcrbzz.2024.05.011 Abstract ( 41)    PDF (985KB) ( 34 )    Objective Through the investigation of a cluster epidemic of fever accompanied by thrombocytopenia syndrome, this study analyzes its clinical characteristics and prognosis to provide evidence for the identification, diagnosis, interpersonal transmission chain, and prevention measures of SFTS cluster epidemics. Method Case searches were conducted based on confirmed indicators, and basic information, incidence, clinical symptoms, and prognosis of the group were collected. Analysis of the causes, transmission routes, clinical symptoms, diagnosis and treatment, and prognostic characteristics of a clustered SFTS outbreak in Hefei, Anhui Province in November 2023. Result This cluster epidemic involved one primary case and ten secondary cases, all of which were family cluster cases. All ten patients had liver dysfunction, eight had thrombocytopenia and leukopenia, five had abnormal coagulation function and elevated myoglobin, seven had positive urine protein, four had hematuria, and three had renal dysfunction;among the 10 secondary cases, 9 improved and 1 died. Conclusion This group of SFTS cluster epidemics has obvious epidemiological characteristics and typical clinical features, which should be taken seriously. Strengthening the management of SFTS fatalities is conducive to reducing the risk of interpersonal transmission.

Case Report

Lepromatous leprosy misdiagnosed as allergic vasculitis:a case report Zhu Qian, Liu Yuqian, Li Jing, Jiang Doukou, Xu Zongyan, Li Xiangzi 2024, 9 (5):  64-67.  DOI: 10.19871/j.cnki.xfcrbzz.2024.05.012 Abstract ( 39)    PDF (1419KB) ( 57 )    This paper report a 25-year-old female patient with erythema and ulceration of lower extremities for 3 years, papules and nodules of back for 6 months. In the past 3 years, she was diagnosed and treated in other hospital for many times, all of which were diagnosed and treated according to "allergic vasculitis" with poor results. The patient was diagnosed as lepromatous leprosy (LL) by skin tissue fluid and pathological examination. Because the patient tested positive for HLA-B13:01, it was not appropriate to take dapsone orally. Rifampicin(600mg/m), moxifloxacin (400mg/d), and chlorphenphenazine(300mg/m, 50mg/d) were given treatment, while methylprednisolone was used to prevent facial neuritis. During treatment, type Ⅱ leprosy reaction occurred, and symptoms were relieved after the addition of thalidomide. At present, the follow-up is still in progress, and the skin lesions have subsided significantly. This case suggests that we still need to further strengthen the training of medical personnel, early detection of leprosy patients, reduce the rate of missed diagnosis and misdiagnosis.Electrophysiological examination, leprae nucleic acid detection, serological tests, MBT(multiplex biomarker test) kits, etc., may have great potential in early identification of leprosy patients and reduce diagnostic delay.

A case of hemophagocytic syndrome caused by pulmonary tuberculosis and tuberculous meningitis in children Wang Ruqiong, Lin Daojiong, Zeng Mei, Zhan Yuefu, Zhou Qionghua, Lin Yi 2024, 9 (5):  68-72.  DOI: 10.19871/j.cnki.xfcrbzz.2024.05.013 Abstract ( 35)    PDF (984KB) ( 53 )    Pulmonary tuberculosis is a common infectious disease in China, and primary syndrome is more common in children. Tuberculous meningitis is the most critical disease among children with tuberculosis, which is progressing rapidly, with high disability and mortality rates. Hemophagocytic syndrome (HLH) is a group of diseases with rapid progress and high mortality, and its incidence rate is high in children. If the patient also has pulmonary tuberculosis, tuberculous meningitis, and hemophagocytic syndrome, early diagnosis and correct treatment are crucial for the patient's prognosis. This article reports a 10-year-old child who sought medical attention due to recurrent fever and cough. Previously healthy with no underlying diseases. The preliminary diagnosis of this illness is pneumonia, and there has been no improvement after active treatment in an external hospital. Bone marrow puncture shows hemophagocytic cells, and the condition worsens and is transferred to our hospital. After admission to our hospital, the diagnosis was severe pneumonia and HLH. HLH was treated according to the guidelines, and antibiotics, fungal infections, and immunoglobulin support therapy were given. The symptoms of the patient did not improve, but the condition continued to worsen. Further examination showed positive Mycobacterium tuberculosis in the cerebrospinal fluid and positive sputum X-pert (rapid molecular identification of tuberculosis and rifampicin resistance). Four combination anti tuberculosis treatment was given, but the patient developed brain herniation in the later stage and died after giving up treatment. This article discusses the clinical manifestation, imaging changes, pathogenic examination, diagnosis and treatment process of hemophagocytic syndrome caused by pulmonary tuberculosis and tuberculous meningitis, so as to improve clinicians' understanding of HLH induced by severe tuberculosis in children.

A case of AIDS complicated with nocardia disease, pseudomonas aeruginosa infection, cytomegalovirus encephalitis and literature review Luo Xingxing, Xie Xiaoxin, Fu Yanhua, Peng Yinshuang, He Jinhong, He Xiangxi, Long Hai 2024, 9 (5):  73-77.  DOI: 10.19871/j.cnki.xfcrbzz.2024.05.014 Abstract ( 33)    PDF (962KB) ( 41 )    This article reported a case of AIDS with multiple infection. The patient was a middle-aged man with AIDS who went to a local hospital for treatment due to symptoms such as cough, sputum and fever, and was transferred to Guiyang Public Health Treatment Center Infection Department after HIV preliminary screening and positive confirmation. After a series of examinations, the patient was initially diagnosed as AIDS combined with lung infection, and the condition did not improve significantly after antibacterial treatment. After multiple sputum culture, fiber bronchoscopeand other examinations, and sent to the alveolar lavage fluid for mNGS detection, the final diagnosis was clearly diagnosed as AIDS complicated with nocardia (nocardia abscess), pseudomonas aeruginosa infection, cytomegalovirus encephalitis. The antiinfective therapy regimen and antiretroviral therapy regimen were adjusted, and the patient improved and was discharged. This case highlights the ability of HIV to attack the human body and organs, which is an important reason for patients with multiple infections and worsening disease. It is not uncommon for people with AIDS to co-exist with other infections, so accurate diagnosis and timely treatment are essential. Through the review of the treatment experience of this case, we hope to strengthen the clinical doctors' ability to diagnose the co-infection of AIDS patients, improve the treatment effect and prolong the life of patients.

Review

Progress in the application of high-throughput sequencing technology in tuberculosis diagnosis and drug resistance detection Zhu Qingdong, Wang Qi, Song Chang, Zhao Chunyan, Yang Shixiong 2024, 9 (5):  78-82.  DOI: 10.19871/j.cnki.xfcrbzz.2024.05.015 Abstract ( 42)    PDF (748KB) ( 66 )    Tuberculosis is a highly contagious and fatal chronic disease. Timely diagnosis and drug resistance testing are crucial for its prevention and control. Although conventional pathogen detection methods play an important role in the diagnosis of tuberculosis, they have certain limitations and are often unable to meet the clinical demands for rapid and accurate diagnosis. High-throughput sequencing technology is increasingly being applied in pathogen detection for infectious diseases, and with technological advancements, it has brought new breakthroughs in the diagnosis and drug resistance testing of tuberculosis. High-throughput sequencing technology can analyze a large number of samples in a short time, quickly identify the gene sequence of Mycobacterium tuberculosis, and detect drug resistance gene mutations, showing great potential and value in the rapid diagnosis and drug resistance testing of tuberculosis. This paper focuses on the application of high-throughput sequencing technologies such as next-generation sequencing (NGS) and third-generation nanopore sequencing in the early diagnosis and monitoring of drug resistance gene mutations in tuberculosis. It discusses the clinical application strategies of sequencing technologies including metagenomic sequencing, targeted sequencing, and whole genome sequencing.

Progress in the relationship between the lung microbiome and the occurrence, development and treatment of lung cancer Sun Xiaoqin, Liu Yu, Shen Xiwen, Hu Weidong 2024, 9 (5):  83-88.  DOI: 10.19871/j.cnki.xfcrbzz.2024.05.016 Abstract ( 37)    PDF (759KB) ( 53 )    The lung was once thought to be sterile, but it is now confirmed to have a certain colonization of microorganisms, playing an important role in the pathogenesis and treatment of respiratory system diseases. Lung cancer, as the world's leading cancer, is a complex disease caused by the interaction of host and environmental factors. Its terrifying aspect is that most patients are diagnosed at a late stage,with a high mortality rate. Increasing evidence suggests that different characteristics of the lung microbiota can identify lung cancer early and have a certain guiding role in the occurrence, development, and treatment of lung cancer. In this review, we summarize the relationship between lung microbiota and lung cancer,characteristic of pulmonary microorganisms in patients with lung cancer,application prospect of microorganisms in the treatment of lung cancer.We hope that the lung microbiota, as an emerging biological marker, can provide new ideas for the diagnosis and treatment of lung cancer, and also propose prospects for future research directions on the lung cancer microbiota.

Standards/Guidelines/Consensus

Dengue diagnosis and treatment protocol (2024 Edition) National Health Commission of the People's Republic of China, National Administration of Traditional Chinese Medicine 2024, 9 (5):  89-93.  DOI: 10.19871/j.cnki.xfcrbzz.2024.05.017 Abstract ( 35)    PDF (713KB) ( 3 )

Interpretation of the Diagnosis and treatment scheme for human infection with avian influenza virus (2024 Edition) Han Bing, Jiang Rongmeng 2024, 9 (5):  94-97.  DOI: 10.19871/j.cnki.xfcrbzz.2024.05.018 Abstract ( 40)    PDF (757KB) ( 28 )    Avian influenza is a zoonotic disease caused by the influenza A virus, primarily affecting birds but also capable of infecting mammals, with sporadic cases in humans. Human infection with avian influenza is an acute respiratory disease caused by certain subtypes of the avian influenza virus, associated with high mortality rates and significant healthcare burdens. To standardize the diagnosis and treatment of human infections with avian influenza, the National Health Commission has developed the Diagnosis and Treatment Plan for Human Infection with Avian Influenza (2024 Edition). This paper provides an analysis of the plan, addressing key aspects such as disease nomenclature, early identification, etiological diagnosis, standardized treatment, and multidisciplinary collaboration. It emphasizes the importance of a unified disease nomenclature under "human infection with avian influenza" and the critical role of epidemiological history in early diagnosis. Additionally, the paper discusses the necessity of nucleic acid testing as the definitive diagnostic standard, introduces new antiviral therapies, highlights the potential risks associated with corticosteroid use, advocates for the appropriate use of antibiotics, and underscores the importance of multidisciplinary collaboration in managing severe cases. These measures are aimed at improving the quality of diagnosis and treatment, thereby reducing the severity and mortality rates associated with human infections with avian influenza.

Interpretation of the Measles diagnosis and treatment guidelines (2024 Edition) Yao Weiming, Lin Yuanlong, Feng Shiyan, Wang Fuxiang 2024, 9 (5):  98-103.  DOI: 10.19871/j.cnki.xfcrbzz.2024.05.019 Abstract ( 35)    PDF (867KB) ( 42 )    Measles is an acute exanthematous respiratory disease caused by the highly contagious measles virus. Its main symptoms include fever, runny nose, cough, watery eyes, photophobia, and maculopapular rash. A small number of patients may develop complications such as pneumonia, laryngitis, otitis media, myocarditis, encephalitis, and severe cases can be fatal. Despite the widespread availability of large-scale vaccination, nearly 136,000 people still died from measles in 2022, with the majority being children under the age of five. In order to further standardize the clinical diagnosis and treatment of measles, the National Health Commission has issued the Measles Diagnosis and Treatment Guidelines (2024 Edition) by integrating domestic and foreign research progress and clinical experience. This article summarizes and organizes the guidelines based on relevant research progress, covering the etiology, epidemiology, pathogenesis, pathological changes, clinical manifestations, laboratory tests, diagnosis and differential diagnosis, treatment, and prevention of measles, aiming to enhance understanding, improve practicality, and provide a basis and reference for clinicians in the prevention and treatment of measles.